Kidney Week

Abstract: FR-PO0636

Remission Kinetics Drive Kidney Outcomes of Podocytopathies in Adults: Insights from a 12-Year Cohort

Session Information

• Glomerular Diseases: Clinical, Outcomes, and Therapeutics Research - ANCA/FSGS
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Anwar, Sohail, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Sohail Anwar, MBBS

• Shaikh, Aisha Farooque, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Aisha Farooque Shaikh, MBBS

• Gharaei, Sophie, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Sophie Gharaei, MBChB

• Gupta, Geetanjali, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Geetanjali Gupta, MBBS

• Hamilton, Patrick, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Patrick Hamilton, MBChB, PhD

• Ragy, Omar Sherin, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Omar Sherin Ragy, MD, FASN

• Kanigicherla, Durga Anil K., Manchester University NHS Foundation Trust, Manchester, England, United Kingdom

Durga Anil K. Kanigicherla, MD

Background

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are the leading causes of adult idiopathic nephrotic syndrome and represent distinct clinical trajectories.It remains unclear whether intrinsic disease biology or differences in remission dynamics drive poorer outcomes in FSGS. Importantly,comparative data in uniformly nephrotic populations are limited.

Methods

We conducted a retrospective cohort study of adults (≥18 years) with biopsy-proven MCD or primary FSGS presenting with nephrotic syndrome (defined as uPCR ≥300 mg/mmol and serum albumin ≤30 g/L) at a UK tertiary centre (2014–2025).Primary outcomes were time to partial remission (PR; uPCR <300 mg/mmol) and complete remission (CR; uPCR <30 mg/mmol). Secondary outcomes included relapse, ≥40% eGFR decline, kidney replacement therapy (KRT), eGFR trajectory, and mortality. Data was analysed using Python (v3.13)

Results

Among 152 patients (85 MCD, 67 FSGS; median follow-up 4.3 years) with comparable baseline proteinuria, MCD achieved higher rates of PR (93% vs 81%; adjusted HR 0.64, 95% CI 0.44–0.93; p=0.019) and CR (87% vs 40%; adjusted HR 0.31, 95% CI 0.19–0.49; p<0.001), with shorter median time to CR (1.9 vs 8.6 months). After CR (n=101), relapse rates were similar (58% vs 59%; p=1.00).
FSGS had significantly higher risk of KRT (24% vs 8%; adjusted HR 4.20, 95% CI 1.29–13.61; p=0.017) and ≥40% eGFR decline (25% vs 5%; adjusted HR 4.95, 95% CI 1.52–16.10; p=0.008). eGFR slope was better in MCD (+2.1 vs −0.6 mL/min/year; p=0.045) but was comparable between groups in those achieving CR (+2.9 vs +3.1; p=0.94). Failure to achieve CR by 6 months identified a high-risk subgroup, with 21% progressing to KRT.

Conclusion

Nephrotic syndrome variant of MCD and FSGS demonstrate markedly different outcomes conferring inferior CR rates and more than 4-fold kidney failure risk, with the transition of PR to CR as the rate-limiting step. Failure to achieve CR at 6 months, identifies a high-risk subgroup.

Multivariable-adjusted hazard ratios for FSGS vs MCD across all outcomes. Red indicates statistical significance (p<0.05)